膜诱导技术结合抗生素硫酸钙颗粒治疗下肢感染性骨缺损

Induced membrane technique combined with antibiotic calcium sulfate pellets in treating infected bone defect in lower extremity

目的探讨膜诱导技术结合抗生素硫酸钙颗粒治疗感染性骨缺损的临床疗效。方法回顾性分析2014年2月至2016年2月治疗9例感染性骨缺损患者资料，男7例，女2例；年龄24~56岁，平均37．0岁；开放性骨折致骨缺损、感染6例，内固定术后感染、骨吸收3例；骨缺损均位于下肢骨干及干骺端，其中股骨3例，胫骨6例。第一阶段手术，彻底清创，残留的骨缺损长度为扣12cm，缺损处填充混有万古霉素的聚甲基丙烯酸甲酯（PMMA）骨水泥，骨缺损的两端用外固定架稳定；6～10周后行第二阶段手术，待局部感染控制取出骨水泥间隔物，在诱导膜内植入抗生素硫酸钙颗粒，缺损较大者混合一定量的自体松质骨颗粒；其中5例继续用外固定架维持固定，3例更换为接骨板固定，1例拆除外架改用石膏固定。术后定期复查x线片，记录相关并发症。根据SamanthaX线评分标准对术后骨愈合进行评分；应用视觉模拟评分（vi．sualanaloguescale，VAS）对术后站立疼痛进行评分；采用Paley方法对骨缺损愈合和邻近关节功能进行评估。结果9例患者均获得随访，随访时间为p15个月，平均9．3个月。第一阶段术后1例患者出现切口愈合不良，经换药保守治疗后治愈。末次随访时所有患者的骨缺损均为影像学骨愈合，愈合时间为10-24周，平均14周。SamanthaX线评分为4~6分，平均4．9分。扶双拐站立时VAS评分为0~3分，平均1．5分。Paley方法评估骨折愈合分级为优；邻近关节功能：优6例，良2例，可1例，优良率为89％（8／9）。9例患者末次随访时无一例感染复发及固定物松动、断裂。结论膜诱导技术结合抗生素硫酸钙颗粒能有效治疗感染性骨缺损。

Objective To evaluate the clinical effects of the Masquelet technique combined with antibiotic calcium sul- fate pellets in treating infected bone defects. Methods From February 2014 to February 2016, 9 patients with infected bone de- fects were treated in our department, including 7 males and 2 females, with an average age of 37.0 years （range, 24-56 years）. 6 cases were infected because of open fractures, 3 infected after internal fixation operation. All defects were located in the lower limb diaphysis and metaphysis （3 cases in femur, 6 cases in tibia）. The length of the bone defects were 4-12 cm after debridement, all defects filled with PMMA loaded with Vaucomycin, and fixed with external fixators. After 6-10 weeks, the bone cement spacers were taken out and the antibiotic calcium sulfate pellets were implanted into the membrane. A certain amount of autogenous can- cellous bone granules would be mixed into the calcium sulfate pellets if the defect was larger than 6-8 cm. 5 cases remained fixed with external fixators, 3 cases replaced for plates, 1 case replaced for plaster external fixator. Regular X-ray foll0w-ups were taken and complications recorded as well. Evaluate the healing of bone defect and functional recovery of adjacent joints by Samantha X score system, visual analogue scale （VAS） and Paley method, respectively. Results The 9 cases were followed up for a mean du- ration of 9.3 months （range, 6-15 months）. All bone defects healed after a mean time of 14 weeks （range, 10-24 weeks）. The wound poor healing occurred in only 1 case in the first stage of surgery, and cured by dressing changes. No complications of the re- currence of infection and implant failure. At the last follow-up, the average Samantha X score was 4.9, the VAS score was 0 to 3 （average 1.5） for patients standing on crutches and all the bone defect healing graded excellent evaluated by Paley method, the functional recovery of the adjacent joints graded： excellent in 6 cases, good in 2 cases, and fair in I case （the excellent and good rate was 89%）. Conclusion Masquelet technique combined with antibiotic calcium sulfate particles is effective in the treatment of infected bone defects.